• Elizabeth Magnan, Daniel J Tancredi, Guibo Xing, Alicia Agnoli, I E Tseregounis, and Joshua J Fenton.
• Department of Family and Community Medicine, University of California, Davis, Sacramento, CA.
• Pain Med. 2024 Nov 25.

ObjectiveTapering of chronic opioids has increased, with subsequent reports of exacerbated pain among patients who tapered. We aimed to evaluate the association between opioid dose tapering and subsequent pain-related healthcare utilization (ED visits, hospitalizations and primary care visits).Design, Setting And SubjectsWe conducted a retrospective cohort study from 2015-2019 using data from the Optum Labs Data Warehouse that contains de-identified retrospective administrative claims data for commercial and Medicare Advantage enrollees in the US. Adults aged ≥18 years who were prescribed stable doses of opioids, ≥50 morphine milligram equivalents (MME)/day, during a 12-month baseline period.MethodsTapering was defined as ≥ 15% relative reduction in mean daily opioid dose during one of 6 overlapping 60-day periods. Tapered patient-periods were subclassified as tapered-and-continued (MME > 0) vs. tapered-and-discontinued (MME = 0). We modeled monthly counts of visits for pain diagnoses up to 12 months after cohort entry using negative binomial regression as a function of tapering, baseline utilization, and patient level-covariates.ResultsAmong 47,033 patients, 13,793 patients tapered. Compared to no taper, any taper was associated with more ED visits for pain (adjusted incidence rate ratio [aIRR] 1.21, 95% CI: 1.11-1.30), tapered then continued status was associated with more ED visits (aIRR 1.23, CI: 1.14-1.32) and hospitalizations (aIRR 1.14, CI: 1.03-1.27) for pain, and tapered-and-discontinued was associated with fewer primary care visits for pain (aIRR 0.68, CI: 0.61-0.76).ConclusionsThese associations suggest that opioid tapering may lead to increased emergency and hospital utilization for acute pain and possibly a decreased perceived need for primary care for those whose opioids were discontinued.© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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